高龄老年和老年社区获得性肺炎的临床特征及预后对照分析  

A case-control study of clinical characterisitics and prognostic factors in 145 elderly patients with community-acquired pneumonia

作　　者：丛燕[1] 赵沄[1] 张颖[1] 许怀宏[1] 李音[1] 

机构地区：[1]复旦大学附属华东医院急诊科,上海200040

出　　处：《老年医学与保健》2009年第2期100-103,共4页Geriatrics & Health Care

摘　　要：目的调查分析老年社区获得性肺炎（CAP）患者的临床特征及预后因素。方法145例住院的老年CAP患者根据年龄分为高龄组（年龄≥80岁）和老年组（年龄65～79岁），回顾性分析各组患者的临床和实验室资料及其预后因素。结果高龄组患者90例，平均年龄（87．2±5．6）岁，老年组55例，平均年龄（74．3±3．9）岁。高龄组38例（42．2％）患者长期卧床，30例（33．3％）合并有冠心病，而老年组分别为12例（21．8％）和9例（16.4％）（P〈0．05）。高龄组患者的血红蛋白和白蛋白水平分别为（112．3±22．2）g／L和（30．7±5.1）g／L，老年组为（120．2±22．0）×10^9g／L和（33．8±5．2）g／L（P〈0．05）。多因素分析表明Ⅱ型呼衰、血K^＋〈3．0mmol／L、呼吸频率〉20次／分是影响老年组CAP患者预后的独立危险因子（P〈0．05）；血红蛋白水平〈100g／L、Ⅰ型呼衰、Ⅱ型呼衰、Fine Ⅴ级是影响高龄组CAP患者预后的独立危险因子（P〈0．05）。结论加强对老年社区获得性肺炎的认识，尤其是对高龄老年CAP患者早期诊断，早期治疗，对改善预后、降低病死率有重要意义。Objective To investigate and analyze clinical characteristics and prognosis of community-acquired pneumonia （CAP） in the elderly. Methods 145 hospitalized old patients with CAP were divided into two groups by age, oldest-older group （〉 80 years） and older group （between 65-79 years）. Clinical and laboratory data on admission were analyzed retrospectively by logistic regression. Results 90 patients （mean age 87.2±5.6 years） were enrolled in the oldest-older group and 55 patients （mean age 74.3±3.9 years） in the older group. Of the 90 patients in the oldest-older group, 38 （42.2%） were bedridden for a long time and 30 （33.3%） suffered from coronary heart disease, which were much higher than those of the older group （P〈0.05）. As compared to the older CAP patients, the oldest-older patients had asignificantly lower levelofhemoglobin [（112.3±22.2） g/L] or albumin [（30.7±5.1） g/L] （P〈0.05）. Multivariate analysis showed that prognostic factors associated with the mortality of the older CAP patients were respiratory failure （type Ⅱ）, hypopotassaemia （〈3.0 mmol/L）, and tachypnea （RR〉20 b/min）. The prognostic factors associated with the mortality of the oldest-older patients were hypohemia （hemoglobin 〈 100g/L）, respiratory failure （type Ⅰ or type Ⅱ） and Fine V. Conclusions CAP is a prevalent disease with unique clinical and prognostic characteristics in old patients. Early diagnosis and treatment of CAP are of primary significance to improve diagnosis and reduce case-fatality.

关 键 词：社区获得性感染 肺炎 老年人 预后 

分 类 号：R563.1[医药卫生—呼吸系统]